Associated Fracture
In the absence of reliable evidence, it is the opinion of the work group that operative fixation (external or internal) should be performed for initial stabilization of long bone fractures with concomitant acute compartment syndrome requiring fasciotomy.
Management of Acute Compartment Syndrome
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: ACS, AOFAS, and SOMOS

Rationale

One low quality study (Kim, 2017) supports the use of either immediate intramedullary nailing or internal fixation in tibial fractures requiring fasciotomy. This study retrospectively reviewed a small cohort of patients who underwent fasciotomy with concomitant intramedullary nailing, internal plate fixation, or external fixation. Patients later underwent delayed fasciotomy closure or skin grafting. The investigators found no difference in functional outcomes or complications.

POSSIBLE HARMS OF IMPLEMENTATION

Early internal fixation with open fasciotomy wounds may lead to contamination of hardware and deep infection. The above study must be interpreted with caution.

FUTURE RESEARCH

In the absence of studies randomizing patients requiring fasciotomy for ACS to either internal or external fixation, analysis of complications and patient outcomes in large, matched, stratified, controlled treatment groups at equal follow up times would be beneficial.


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